Avascular necrosis of vertebral body with fracture of unilateral posterior facet at the level of insertion of interspinous device

This report shows a rare case of avascular necrosis of vertebra body after insertion of interspinous device after insertion of interspinous device and its plausible cause. A 82-year-old woman presented with severe back pain for 1 week without injury. In her history, she had undergone decompression and implantation of L4-5 interspinous device for the relief of neurogenic claudication at 4 year ago. Magnetic resonance image demonstrated signal change suggesting avascular necrosis of L5 vertebra body and fracture of posterior facet after insertion of interspinous device. In this case, avascular necrosis of lumbar vertebra body was documented with simple radiograph and MRI and symptom was satisfactorily relieved with conservative treatment. Avascular necrosis of lumbar vertebra body can occur as a complication of interspinous process device. Surgeons always must consider the possibility of avascular necrosis of vertebral body in patients with osteoporosis after insertion of interspinous device.

[1]  K. Chung,et al.  Stress Fracture of Bilateral Posterior Facet After Insertion of Interspinous Implant , 2009, Spine.

[2]  Sheng-Li Huang,et al.  Avascular necrosis of a vertebral body. , 2009, Chinese journal of traumatology = Zhonghua chuang shang za zhi.

[3]  Bang-Bin Chen,et al.  Vertebral osteonecrosis: MR imaging findings and related changes on adjacent levels. , 2007, AJNR. American journal of neuroradiology.

[4]  S. Yerby,et al.  The Effects of an Interspinous Implant on the Kinematics of the Instrumented and Adjacent Levels in the Lumbar Spine , 2003, Spine.

[5]  T. Faciszewski,et al.  Intravertebral clefts in osteoporotic vertebral compression fractures. , 2003, Arthritis and rheumatism.

[6]  R. Lopez-Ben,et al.  Vertebral Osteonecrosis Related to Intradiscal Electrothermal Therapy: A Case Report , 2003, Spine.

[7]  S. Yerby,et al.  The Effects of an Interspinous Implant on Intervertebral Disc Pressures , 2003, Spine.

[8]  M. Matoba,et al.  MR imaging of subchondral osteonecrosis of the vertebral body after percutaneous laser diskectomy. , 1999, AJR. American journal of roentgenology.

[9]  R. Knight,et al.  Idiopathic Avascular Necrosis of a Vertebral Body: Case Report and Literature Review , 1997, Spine.

[10]  D. C. Henckel,et al.  Case report. , 1995, Journal.

[11]  J L Lewis,et al.  Experimental measurement of ligament force, facet force, and segment motion in the human lumbar spine. , 1993, Journal of biomechanics.

[12]  V. Kováč,et al.  Diagnosis of ischemic vertebral collapse using selective spinal angiography. , 1981, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[13]  A. Nachemson,et al.  Lumbar intradiscal pressure. Experimental studies on post-mortem material. , 1960, Acta orthopaedica Scandinavica. Supplementum.